硝酸甘油对轻中度高血压患者脉搏波速度的影响

Effects of nitroglycerin on pulse wave velocity in patients with mild and moderate hypertension

目的探讨脉搏波速度（PWV）升高的轻中度原发性高血压患者含服硝酸甘油后大动脉弹性的改变及临床意义。方法选取轻中度原发性高血压且测量PWV大于1400cm／s的患者共779例，分为单纯高血压组（114例）、伴有1个危险因素组（262例）、伴有2个危险因素组（255例）及伴有3个危险因素组（148例），给予硝酸甘油0．5mg含化后2min重新测定血压及PWV，并进行统计学分析。结果患者含服硝酸甘油后收缩压由（149±15）mmHg下降至（135±20）mmHg，脉压由（59±12）mmHg下降至（50±11）mmHg，PWV由（1688±378）cm／s下降至（1329±288）cm／s，服药前后比较，差异均有统计学意义（t值分别为3．036、2．473、3．885，均P〈0．05）；随着危险因素的增多，含服硝酸甘油后大动脉弹性改善程度减小；单纯高血压组、伴有1个危险因素组、伴有2个危险因素组、伴有3个危险因素或靶器官损害组PWV改善率分别为89．1％、74．3％、72．6％和44．0％。结论收缩压及脉压水平与大动脉弹性明显相关，含硝酸甘油后由于收缩压及脉压水平下降致大动脉僵硬度有所改善；高血压伴危险因素越多者血管弹性越差，且对硝酸甘油敏感性越差。

Objective To explore the changes of elasticity in the large arteries and its clinical significance of sublingnal administration of nitroglycerin in patients with elevated PWV, and mild and moderate essential hypertension. Methods Totally, 779 patients with mild and moderate hypertension and PWV more than 1400 cm/s were selected and divided into four groups, one with simple hypertension, the second one with only one risk factor for it, the third one with two risk factors, and the fourth one with three risk factors or damage in their target organs. Sublingnal administration of 0. 5 mg nitroglycerin was administered and blood pressure and PWV were measured for all of them, and data were statistically compared and analyzed by groups and before and after nitroglycerin administration. Results Systolic blood pressure decreased to （ 135 ± 20） mm Hg from （ 149 ± 15 ） mm Hg, pulse pressure decreased to （ 50 ± 11 ） mm Hg from （59 ± 12） mm Hg, PWV decreased to （1329 ±288） cm/s from （1688 ±378） cm/s, respectively, after nitroglycerin treatment for hypertensive patients （ t = 3. 036, 2. 473, 3. 885, all P 〈 0. 05）. Improvement of elasticity of the large arteries in them after nitroglycerin treatment inversely correlated with the number of risk factors for hypertension they had, with 89. 1 percent, 74. 3 percent, 72. 6 percent and 44. 0 percent of improvement in PWV, respectively for those with simple hypertension, only one risk factor, two risk factors and three risk factors or with damage in target organs. Conclusions Systolic blood pressure and pulse pressure significantly correlated with elasticity of the large arteries in hypertensive patients, and their stiffness improved after sublingual administration of nitroglycerin due to decrease in systolic blood pressure and pulse pressure. The more risk factors the hypertensive patients had, the poorer elasticity of their large arteries and less sensitive to nitroglycerin treatment were.